Speaking of Individual Responsibility...

April 7, 2010

Harold Pollack is a professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment.

The current Pediatrics includes a timely article, which in its way is as frustrating as any account of Tea Party protesters shouting about death panels. The article by David Sugerman and colleagues recounts a 2008 measles outbreak in San Diego. This outbreak began when an intentionally unvaccinated 7-year-old contracted measles on a trip to Switzerland. The boy unintentionally exposed 839 people before the outbreak was contained. Three-quarters of those who actually became infected were intentionally unvaccinated. Seventy-three unvaccinated children (including 48 who were too young to be vaccinated) were placed under 21-day quarantine. As is often the case, geographic and school clustering of intentionally unvaccinated and under-vaccinated children provided an epidemiological niche in which infection was especially likely to spread.

This is not a story about a low-income community lacking basic information or access to medical services. Most of the parents who chose not to vaccinate their children were college educated. A large proportion of parents who chose not to vaccinate had six-figure incomes. Fortunately the overall community had strong vaccination coverage. Public health authorities effectively intervened, and the outbreak was contained. The measureable economic cost of this outbreak and its control was estimated at about $176,000. The intangible costs were surely much higher. This is such a frustrating waste of time and resources.

We also live generally free of the ravages of infectious childhood disease. Parents are understandably tempted to avoid the potential adverse effects of immunization in the hope that herd immunity will still protect their children. I think this is a bad bet. In this era of constant population movement, airplane travel, and immigration, you don't know what bug the guy next to you in the subway might really be carrying.

Intentional unvaccination is most obvious in the case of measles, but it shows up in other arenas, too. We could save thousands of lives if young people got their flu shots every year, for example.

Some people want to tighten the legal requirements for vaccination. I'm not willing to take this step. I'm not in the camp that wants to berate parents who choose not to vaccinate their kids, either. Many of these parents have had real experiences with the health care system that lead them to distrust it. We need to win that trust back through persuasion rather than through compulsion.